Diabetes Health

Diabetes Linked to Depression During and After Pregnancy

Low-income women with diabetes who are pregnant or who recently gave birth face almost twice the risk of depression compared to women without diabetes, says a study in the Journal of the American Medical Association.

And, it did not matter whether the women developed diabetes before or during pregnancy, or if they were taking insulin or oral medications. The risk of depression was still much stronger for those women.

"Those with diabetes have nearly twice the risk of depression during pregnancy and post-partum," says study lead author, Katy Backes Kozhimannil, at Harvard Medical School in Boston.

Furthermore, women who had never been depressed before appeared to be at risk, too. "One in 10 women who had no indication of prior depression received a diagnosis of depression within a year following delivery," says Kozhimmanil.

Diabetes Link More than Doubles Risk

Although the study did not look at potential reasons for this association, Kozhimannil says there are biological changes that occur with diabetes that might increase the risk of depression. She also notes that the stress of managing a chronic illness might contribute to the risk of depression.

Post-partum depression affects about 10 percent of new mothers, usually between two and six months after birth, according to background information in the study. If left untreated, post-partum depression can affect the mother-child relationship as well as the child's development.

Risk factors for post-partum depression include a history of depression, troubled relationships, domestic violence, stressful life events, financial problems, lack of social or emotional support, a difficult pregnancy or delivery, and health problems with the baby.

According to the study authors, previous studies have linked diabetes to an increased risk of depression in general.

To assess whether or not diabetes is a factor in pre- and post-partum depression, Kozhimannil and her colleagues reviewed data on more than 11,000 women who gave birth between 2004 and 2006. All of the women were continuously enrolled in Medicaid during the study period.

From this low-income population, the researchers found that 15.2 percent of women with diabetes developed depression during or after their pregnancy. In women without diabetes, that number was 8.5 percent.

In women who had never been depressed before, 9.6 percent of those with diabetes developed depression, compared to 5.9 percent of those without the blood sugar condition.

"Health-care facilities need to pay particular attention for depression in women with diabetes during the post-partum period," says Kozhimannil. "Both diabetes and depression in the post-partum period are treatable."

Look Closer at Socio-Economic Factors

Dr. Robert Welch, a chairman of obstetrics and gynecology at Providence Hospital in Southfield, MI, called the new research an interesting study, but said it left some important questions unanswered.

For example, he wondered how many of these pregnancies were planned, and exactly how many of the women with diabetes were newly diagnosed?

"A new diagnosis may be overwhelming for a lot of women," he notes.

Also, in a Medicaid population, says Dr. Welch, it can be more difficult to get diabetes well monitored, which could add to the stress these women are already feeling.

"Diabetes is an expensive disease, and this study calls out the need for additional mid-level providers who have more time to assist in making [a depression] diagnosis," he explains.

Both Dr. Welch and Kozhimannil say that while this study was done with low-income women, the findings may be similar for higher-income women, though the stressors might be different.

"Years ago, when you brought a baby home, grandma and other family members were there. Now, grandmothers are working. And, if you have diabetes, too, it's an overwhelming situation. You're fatigued from the new baby and have the stress of managing diabetes," he says.

Dr. Welch recommends that no matter what your income, if you are expecting, you should try to set up a support system before the baby arrives. Try to set up extra help so you are not alone with the baby day after day.

Always consult your physician for more information.

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Understanding Diabetes in Pregnancy

Gestational diabetes is a condition in which the glucose level is elevated and other diabetic symptoms appear during pregnancy in women who have not previously been diagnosed with diabetes.

All diabetic symptoms disappear following delivery.

Unlike type 1 diabetes, gestational diabetes is not caused by a lack of insulin but by the blocking effects of other hormones on the insulin that is produced. This condition is referred to as insulin resistance.

Approximately 7 percent of all pregnant women in the US are diagnosed with gestational diabetes.

Although the cause of gestational diabetes is not known, there are some theories as to why the condition occurs.

The placenta supplies a growing fetus with nutrients and water and produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin.

This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater.

Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

Although any woman can develop gestational diabetes during pregnancy, some of the factors that may increase the risk include: being obese, having a family history of diabetes, giving birth to a large infant, having a still born child or a child with a birth defect, or having too much amniotic fluid.

Age can also be a factor. Women who are older than 25 are at a greater risk for developing gestational diabetes than younger women.

Although having an increased glucose level in the urine is often cited as a risk factor, it is not believed to be a reliable indicator for gestational diabetes.